Radial Artery Harvesting Research Articles

RN First Assistants Expand Their Perioperative Role

At the Cleveland Clinic Foundation, the RN first assistant (RNFA) role has expanded to include radial artery (RA) harvesting for coronary artery bypass surgery. This new role encompasses preoperatively assessing the RA with the Allen's test and perfusion index; intraoperatively removing the RA, dissecting the RA as a pedicle, and maintaining hemostasis and wound closure; and postoperatively collaborating with the postoperative muse clinician during patient care and management in the intensive care unit. This article outlines the RNFA's expanded role in this detailed surgical procedure.

Routine Use of Unilateral and Bilateral Radial Arteries for Coronary Artery Bypass Graft Surgery

Objectives. This study sought to evaluate the routine use of radial artery (RA) grafts in patients undergoing coronary artery revascularization.Background. Previous long-term studies have documented poor patency of saphenous vein grafts compared with internal thoracic artery (ITA) grafts.Methods. We performed a prospective review of 175 of 249 consecutive patients.Results. Fifty-four patients had bilateral RAs harvested. Mean number (±SD) of grafts/patient was 3.27 ± 0.93, with 2.76 ± 0.97 arterial grafts; a mean of 1.53 ± 0.68 grafts were performed with the RA. The operative mortality rate was 1.6%. No deaths were related to RA grafts, and there were no RA harvest site hematomas or infections. Transient dysesthesia 1 day to 4 weeks in duration occurred in the distribution of the lateral antebrachial cutaneous nerve in six extremities (2.6%). Elective cardiac catheterization in 60 patients at 12 weeks postoperatively demonstrated a 95.7% patency rate.Conclusions. Because of potential benefit of long-term patency associated with arterial grafts, minimal morbidity and mortality associated with use of the RA and excellent short-term patency rates, we cautiously recommend use of one or both RAs as additional conduits to be used concomitantly with the ITA for arterial revascularization of the coronary arteries.

Safe removal of the radial artery for myocardial revascularization: A doppler study to prevent ischemic complications to the hand

Radial artery harvesting has recently been reintroduced for myocardial revascularization. Harvesting the radial artery may jeopardize the vascularization of the hand; cautious selection of candidates must therefore be pursued. The study involved 188 consecutive patients. We verified the patency of the upper limb's arteries and the adequacy of the ulnar supply by static and dynamic Doppler evaluations. The use of the radial artery was contraindicated in 14 cases (three for stenosis of the subclavian artery and 11 for inadequate collateralization). One hundred patients were operated on with the radial artery used as a graft; the remaining 74 patients had a different conduit placed. The vascularization of the hand was restudied within 10 days in all patients who underwent operation; in 63 patients, it was studied again at 1 year. The early Doppler examination showed significant increase in blood flow velocities in the ulnar artery, with a flow redistribution in the common digital palmar arteries (decreased in the first and increased in the second and the third). The late Doppler examination showed superimposable findings. No local ischemic complications were observed. We conclude that Doppler study is a useful tool in preoperative screening of candidates for radial artery harvesting for myocardial revascularization. (J T HORAC C ARDIOVASC S URG 1996;112:737-44)

Technique for harvesting the radial artery as a coronary artery bypass graft

The radial artery was proposed and then abandoned as a coronary artery bypass graft in the 1970s. Development of new pharmacologic antispasmodic agents and minimally traumatic harvesting techniques has led to a revival of the use of the radial artery in coronary artery bypass procedures. Unlike the saphenous vein in the lower extremities, the radial artery in the volar forearm is not a subcutaneous structure. Safe harvest of the artery requires an understanding of volar forearm anatomy. Based on review of anatomy, cadaver dissection, and clinical experience with 40 patients, we have developed a technique for radial artery harvest. The volar forearm is divided into three zones: the proximal zone, the middle zone, and the distal zone. In each zone, important anatomic landmarks are identified. Our harvesting technique has resulted in minimal postoperative morbidity and no postoperative ischemic complications. Although the pedicled internal thoracic artery graft remains the primary arterial conduit for myocardial revascularization, the radial artery is an excellent additional bypass conduit.